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Wang H, Zhao Z, Cao Q, Ning J. A review of 17 cases of mesenteric panniculitis in Zhengzhou Ninth People's Hospital in China. BMC Gastroenterol 2024; 24:48. [PMID: 38267839 PMCID: PMC10809466 DOI: 10.1186/s12876-024-03136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE Mesenteric panniculitis (MP) represents the uncommon, benign and chronic inflammatory disorder affecting the mesenteric adipose tissues. Its etiology, diagnosis and treatment remain unnoticed. Our report focused on shedding more lights on this condition. PATIENTS AND METHODS Seventeen MP patients were identified by searching the electronic medical record system in the Zhengzhou Ninth People's Hospital using the search terms "Mesenteric panniculitis" from October 2015 to March 2023. All cases were diagnosed with MP through computed tomography (CT). Their clinical features and treatments were analyzed. RESULTS There were altogether 17 cases enrolled for this analysis. The male to female ratio was 8:9, and the median age at diagnosis was 64 (range: 37-96) years. There were 15 patients (88.2%) showing abdominal pain to varying degrees. The proportions of symptoms of nausea, vomiting and fever were 23.5%, 23.5% and 41.2%, respectively. Neoplastic disease was present in 3 patients (17.6%). Meanwhile, 9 patients (52.9%) had gallstones, 3 (17.6%) had cholecystitis and 1 (5.9%) had gallbladder polyps. Six patients (35.3%) received antibiotics treatment only and 1 (5.9%) received oral antibiotics and prednisone. One patient (5.9%) received antibiotics followed by prednisone treatment, because the symptoms were significantly relieved after antibiotic treatment, while the disease recurred soon after, and the symptoms improved again after prednisone treatment. The abdominal pain in 9 patients (52.9%) was relieved spontaneously. Two patients (11.8%) died, including one due to respiratory failure caused by pneumonia and the other one because of pancreatic cancer with lung and liver metastases. CONCLUSION MP is a poorly understood chronic inflammatory disease. Patients often have abdominal pain as the main symptom, accompanied by comorbidities in the gallbladder, and the prognosis is usually good after correct diagnosis and treatment, Therefore, the present report aims to promote the awareness among clinicians of patients with non-classic abdominal symptoms, so as to avoid misdiagnosis or missed diagnosis.
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Affiliation(s)
- Hongyan Wang
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Zhenyu Zhao
- Radiology, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Qiucai Cao
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China
| | - Jing Ning
- Geriatric Center, Zhengzhou Ninth People's Hospital, 25 Sha Kou Road, 450008, Zhengzhou, Henan, China.
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Mohamed H, Mehdi C, Ikram M, Myriam M, Habib B, Adnene C. [Mesenteric panniculitis associated with acute pancreatitis: about a case]. Pan Afr Med J 2016; 24:206. [PMID: 27795801 PMCID: PMC5072865 DOI: 10.11604/pamj.2016.24.206.9322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/08/2016] [Indexed: 11/11/2022] Open
Abstract
Mesenteric panniculitis is a nonspecific inflammation involving the mesentery. Its clinical presentation is variable depending on the stage of the disease. Clinical signs are usually pain but half of the patients remain asymptomatic. Palpable abdominal mass, weight loss, nausea and vomiting. There may be an inflammatory syndrome of variable intensity. Panniculitis is suspected based on scan showing hyperdense mesentery with adhesions to adjacent organs. Histologically there is adipocyte degeneration causing foreign body reaction and appear lymphoplasmacytic inflammatory lesions. We report a new case of mesenteric panniculitis associated with acute pancreatitis.
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Affiliation(s)
- Hedfi Mohamed
- Service de Chirurgie Générale Hôpital Des FSI La Marsa, Tunisie
| | - Charfi Mehdi
- Service de Chirurgie Générale Hôpital Des FSI La Marsa, Tunisie
| | - Messaoudi Ikram
- Service de Chirurgie Générale Hôpital Des FSI La Marsa, Tunisie
| | - Moussa Myriam
- Service de Chirurgie Générale Hôpital Des FSI La Marsa, Tunisie
| | - Bouhawala Habib
- Service de Chirurgie Générale Hôpital Des FSI La Marsa, Tunisie
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Tavares Pereira JP, Romão V, Eulálio M, Jorge R, Breda F, Calretas S, Leitão S, Eugénio G, Santos R, Carvalho A. Sclerosing Mesenteritis and Disturbance of Glucose Metabolism: A New Relationship? A Case Series. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:55-9. [PMID: 26848804 PMCID: PMC4743678 DOI: 10.12659/ajcr.896145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sclerosing mesenteritis is an idiopathic inflammatory and fibrotic disease that affects the mesentery. It is a rare disease, with the total number of reported cases in the literature ranging from 122 to 300. It mainly affects men in the sixth decade of life, and its etiology remains unknown. Clinical presentation is variable, but it is frequently asymptomatic. Diagnosis is often made by computed tomography (CT) scan, although biopsy may be needed for confirmation. An association between other diseases (e.g., neoplasms) and sclerosing mesenteritis has been described, but the relationship between the latter and glucose changes is not disclosed in the currently available literature. CASE REPORT Five cases of sclerosing mesenteritis and glucose metabolism disorders (impaired fasting glucose and type 2 diabetes mellitus) were retrospectively collected and analyzed. The mean age was 65 ± 9.3 years, 80% were male, and all patients were white. Three patients were asymptomatic and the other 2 (40%) had non-specific chronic abdominal pain. Blood tests revealed normal inflammatory parameters (mean HbA1c was 6.4% and fasting blood glucose was 140 mg/dL). The diagnosis was made by abdominal CT scan. The 2 symptomatic patients underwent therapy with colchicine 1 mg/day, with clinical improvement. During the mean 43-month follow-up period, there was no symptomatic progression, thereby maintaining the usual benign course of this condition. CONCLUSIONS Sclerosing mesenteritis has only been described in small series and isolated cases, but its diagnosis is becoming more common due to greater access to diagnostic methods and higher awareness of the disease in the medical community. Furthermore, despite the small sample size, we describe a possible association between glucose metabolism impairment and sclerosing mesenteritis.
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Affiliation(s)
| | - Vera Romão
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Eulálio
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rita Jorge
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Filipe Breda
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Suzana Calretas
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sara Leitão
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Gisela Eugénio
- Department of Rheumatology, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui Santos
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
| | - Armando Carvalho
- Department of Internal Medicine, Centro Hospiatalar e Universitário de Coimbra, Coimbra, Portugal
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Masulovic D, Jovanovic M, Ivanovic A, Stojakov D, Micev M, Stevic R, Filipovic A, Galun D. Sclerosing Mesenteritis Presenting as a Pseudotumor of the Greater Omentum. Med Princ Pract 2016; 25:93-5. [PMID: 26436663 PMCID: PMC5588320 DOI: 10.1159/000441454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 10/04/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim was to demonstrate a diagnostic challenge of sclerosing mesenteritis initially considered as liposarcoma. CLINICAL PRESENTATION AND INTERVENTION A 45-year-old man was admitted with a painful abdominal mass. Abdominal computed tomography demonstrated a well- demarcated tumor in his left hemiabdomen, with a large fat component and areas of soft tissue attenuation suggestive of liposarcoma. Intraoperative findings showed a tumor arising from the greater omentum. The tumor was completely removed, and histopathology confirmed a pseudotumorous type of sclerosing mesenteritis with dominant mesenteric lipodystrophy. CONCLUSION This case showed that a pseudotumorous type of sclerosing mesenteritis should be considered in the differential diagnosis of the mesenteric tumors.
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Affiliation(s)
- Dragan Masulovic
- Department of Pathology, Faculty of Medicine, University of Belgrade, Serbia
- Department of Pathology, Center of Radiology and MRI, Belgrade, Serbia
| | | | - Aleksandar Ivanovic
- Department of Pathology, Faculty of Medicine, University of Belgrade, Serbia
- Department of Pathology, Center of Radiology and MRI, Belgrade, Serbia
| | - Dejan Stojakov
- Department of Pathology, Faculty of Medicine, University of Belgrade, Serbia
- Department of Pathology, HPB Unit, Belgrade, Serbia
| | - Marjan Micev
- Department of Pathology, Clinic for Digestive Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Ruza Stevic
- Department of Pathology, Faculty of Medicine, University of Belgrade, Serbia
- Department of Pathology, Center of Radiology and MRI, Belgrade, Serbia
- *Ruza Stevic, Center of Radiology and MRI, Clinical Center of Serbia, Pasterova 2, RS–11000 Belgrade (Serbia), E-Mail
| | | | - Danijel Galun
- Department of Pathology, Faculty of Medicine, University of Belgrade, Serbia
- Department of Pathology, HPB Unit, Belgrade, Serbia
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Kakimoto K, Inoue T, Toshina K, Yorifuji N, Iguchi M, Fujiwara K, Kojima Y, Okada T, Nouda S, Kawakami K, Abe Y, Takeuchi T, Egashira Y, Higuchi K. Multiple Mesenteric Panniculitis as a Complication of Sjögren's Syndrome Leading to Ileus. Intern Med 2016; 55:131-4. [PMID: 26781011 DOI: 10.2169/internalmedicine.55.5407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mesenteric panniculitis (MP) is a benign fibroinflammatory process characterized by the presence of fat necrosis, chronic inflammation and fibrosis in the mesentery. Although various causal factors, such as malignancy, chronic inflammatory conditions and autoimmune processes, have been identified, the precise etiology remains unknown. We herein report a rare case of MP accompanying Sjögren's syndrome in which a mass lesion and intestinal stenosis were observed simultaneously. This condition led to ileus, which was effectively treated using prednisolone.
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Affiliation(s)
- Kazuki Kakimoto
- Second Department of Internal Medicine, Osaka Medical College, Japan
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Rumman N, Rumman G, Sharabati B, Zagha R, Disi N. Mesenteric panniculitis in a child misdiagnosed as appendicular mass: a case report and review of literature. SPRINGERPLUS 2014; 3:73. [PMID: 25191632 PMCID: PMC4153878 DOI: 10.1186/2193-1801-3-73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/31/2014] [Indexed: 12/21/2022]
Abstract
Mesenteric panniculitis is a chronic inflammatory process involving the adipose tissue of the mesentery. The etiology is unknown, and it is rare in children. We report a 5 year old girl who presented with abdominal symptoms and was misdiagnosed as appendicular mass. The correct diagnosis was established after surgical resection.
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Affiliation(s)
- Nisreen Rumman
- Department of Pediatrics, Makassed Hospital, Jerusalem, Palestine
| | - George Rumman
- Department of Pediatric Surgery, Makassed Hospital, Jerusalem, Palestine
| | | | - Rami Zagha
- Department of Pathology, Al-Najah National University, Nablus, Palestine
| | - Nimer Disi
- Department of Pediatric Surgery, Makassed Hospital, Jerusalem, Palestine
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Shi YM, Chang J, Huang H. Sclerosing mesenteritis with digestive hemorrhage as the first sign: A case report. Shijie Huaren Xiaohua Zazhi 2013; 21:3920-3922. [DOI: 10.11569/wcjd.v21.i34.3920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Sclerosing mesenteritis is a rare inflammatory disease of the mesentery. It produces tumor-like masses of the mesentery characterized by varying degrees of fibrosis, chronic inflammation, and fat necrosis. Although sclerosing mesenteritis can be related to autoimmune disorder, ischemia, infection, drugs and surgery, most cases are idiopathic. Clinical manifestations are nonspecific, varying from asymptomatic to diffuse abdominal complaints. Radiologic examinations and histologic evaluation of a biopsy specimen are the key to the correct diagnosis. There is no consensus on optimal pharmaceutical treatment and most patients are treated empirically. Herein we report a case of sclerosing mesenteritis with digestive hemorrhage as the first sign in a 60-year-old man.
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Gunduz Y, Tatli APL, Kara RO. Mesenteric panniculitis: a case report and review of the literature. MAEDICA 2012; 7:344-7. [PMID: 23483843 PMCID: PMC3593287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 10/30/2012] [Indexed: 06/01/2023]
Abstract
Mesenteric panniculitis is a benign disease characterized chronic nonspecific inflammation of the mesentery adipose tissue of the small intestine and colon. The specific etiology of the disease is unknown. The diagnosis is suggested by computed tomography (CT) and is usually confirmed by surgical biopsies. In recent years, abdominal CT is used as an effective method for diagnostic evaluation.We reported a case of the mesenteric panniculitis diagnosed with CT and operated for acute pancreatitis and cholecystitis five years ago.
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Affiliation(s)
- Yasemin Gunduz
- Sakarya University Medical Faculty, Deparment of Radiology, Sakarya, Turkey
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Sclerosing mesenteritis: A rare case of large bowel and rectum involvement. Arab J Gastroenterol 2012; 13:93-6. [PMID: 22980600 DOI: 10.1016/j.ajg.2012.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 08/10/2010] [Accepted: 02/22/2012] [Indexed: 12/25/2022]
Abstract
Sclerosing mesenteritis (SM) is an uncommon non-neoplastic inflammatory process in the mesentery that is seen as a pseudotumour, usually involving the small-bowel mesentery and, less commonly, the mesentery of the large bowel. The disease has two well-established histological types: the acute or sub-acute form known as mesenteric panniculitis and the chronic form known as retractile or SM. Because SM lacks special clinical manifestation and typical signs, the possibility of misdiagnosis is very high. The correct diagnosis of SM depends on pathological examination. Here in, we report a case of a 41-year-old male patient with SM of the large bowel.
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Daumas A, Agostini S, Villeret J, Ah-Soune P, Emungania O, Granel B. Spontaneous resolution of severe, symptomatic mesocolic panniculitis: a case report. BMC Gastroenterol 2012; 12:59. [PMID: 22672224 PMCID: PMC3449199 DOI: 10.1186/1471-230x-12-59] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 06/06/2012] [Indexed: 02/08/2023] Open
Abstract
Background Mesenteric panniculitis is a rare chronic fibrosing inflammatory disease that typically affects the adipose tissue and mesentery of the small intestine but may also affect the mesosigmoid and the mesocolon. The pathology of this disease remains unclear despite association with some malignancies or inflammatory disorders. We report a case of mesocolic panniculitis and a literature review of its clinical presentation, imaging findings, associated conditions and treatment options. Case presentation A 64 year-old Caucasian man was admitted to the gastroenterology department for severe weakness, left lower quadrant abdominal pain, weight loss and diarrhoea. Physical examination revealed a palpable firm mass occupying the entire left part of the abdomen. Abdominal CT-scan showed fatty infiltration of the mesosigmoid and left mesocolic fat which was strongly suggestive of panniculitis. Laparoscopic surgery revealed an inflamed and edematous mesocolon and mesosigmoid; the sigmoid mucosa appeared petechial which was suggestive of venous ischemia. Histological examination of surgical biopsies revealed mesocolic panniculitis. Despite exhaustive investigation, no associated conditions were found and the cause was classified as idiopathic. Surprisingly, the patient clinically improved without therapeutic intervention other than supportive care. Conclusion Although mesenteric panniculitis is most often a radiographic diagnosis without clinical symptomatology, it can also present with significant general status alteration. We report a case of mesocolic panniculitis complicated by development of an inflammatory mass associated with ischemic colitis. Mesenteric panniculitis is a difficult diagnosis to make which typically requires histologic confirmation. The overall prognosis is good with supportive treatment.
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Affiliation(s)
- Aurélie Daumas
- Service de Médecine Interne, Assistance Publique-Hôpitaux de Marseille-AP-HM, Université AIX-MARSEILLE, Hôpital Nord, Chemin des Bourrely, 13915 Marseille Cedex 15, France.
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Avelino-Silva VI, Leal FE, Coelho-Netto C, Cotti GCDC, Souza RAS, Azambuja RL, Rocha MDS, Kallas EG. Sclerosing mesenteritis as an unusual cause of fever of unknown origin: a case report and review. Clinics (Sao Paulo) 2012; 67:293-5. [PMID: 22473414 PMCID: PMC3297042 DOI: 10.6061/clinics/2012(03)16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Irandoost P, Silva KD. Case report of sclerosing mesenteritis. Pathology 2012. [DOI: 10.1016/s0031-3025(16)32829-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Multidetector-row computed tomography findings of sclerosing mesenteritis with associated diseases and its prevalence. Jpn J Radiol 2011; 29:495-502. [PMID: 21882092 DOI: 10.1007/s11604-011-0587-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 03/09/2011] [Indexed: 12/15/2022]
Abstract
PURPOSE Our aim was to report the multidetector-row computed tomography (MDCT) findings of sclerosing mesenteritis, which is a rare disease characterized by chronic nonspecific inflammation of mesenteric adipose tissue. It has associated diseases, and we explored its prevalence. MATERIALS AND METHODS A total of 2100 patients were evaluated retrospectively for sclerosing mesenteritis between December 2007 and May 2009. Signs and symptoms, associated diseases, laboratory data, surgical histories, and related findings of a misty mesentery, which corresponds to sclerosing mesenteritis on MDCT, were recorded. RESULTS Misty mesentery findings were seen in 51 (2.43%; 35 men) patients. Their ages ranged between 33 and 78 years (mean 56.2 years). The most frequent complaint of patients was abdominal pain (n = 19; 37.2%). The most prominent possible causative and/or associated factors in our study were malignancy (n = 9; 17.6%), previous surgery (n = 17; 33.3%), smoking (n = 20; 39.2%), coronary artery disease (n = 9; 17.6%), urolithiasis (n = 10; 19.6%), hypertension (n = 18; 35.2%), hyperlipidemia (n = 13; 25.5%), and diabetes mellitus (n = 11; 21.5%). On MDCT, density values in mesenteric fat (-62.8 ± 18.6 HU) were significantly higher than the values for subcutaneous (-103.9 ± 5.8 HU) and retroperitoneal (-105 ± 6 HU) fatty tissues (both P < 0.0001). A partially hyperdense stripe (n = 37; 72.6%), well-defined soft tissue nodules (100%), hypodense fatty halo enclosing vessels (n = 1; 1.9%), and nodules (n = 12; 23.5%) were demonstrated in most of the patients. CONCLUSION The diagnosis of sclerosing mesenteritis has increased with the more frequent use of MDCT and the popularization of the DICOM viewer. Defined hallmarks on MDCT can be helpful for differentiating sclerosing mesenteritis from other pathologies.
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Parampalli U, Banerjee S, Dey SR, Saeed I, Khoo DE. An unusual presentation of sclerosing mesenteritis mimicking inflammatory bowel disease in a teenager. JRSM SHORT REPORTS 2011; 2:16. [PMID: 21541084 PMCID: PMC3086324 DOI: 10.1258/shorts.2011.010073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Umesh Parampalli
- Department of General Surgery, Worthing Hospital , Worthing, West Sussex , UK
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Kida T, Suzuki K, Matsuyama T, Okita M, Isozaki Y, Matsumoto N, Miki S, Nagao Y, Kawabata K, Kohno M, Oyamada H. Sclerosing mesenteritis presenting as protein-losing enteropathy: a fatal case. Intern Med 2011; 50:2845-9. [PMID: 22082901 DOI: 10.2169/internalmedicine.50.5251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Sclerosing mesenteritis is a rare, benign disorder characterized by non-specific and chronic inflammation of the mesenteric adipose tissue. The disease usually presents with gastrointestinal symptoms and abdominal masses. The long-term prognosis is favorable, but it often becomes severe. In the present report we describe a 77-year-old man who presented with diarrhea, massive ascites and an abdominal mass. The rapid deterioration of the general condition of the patient limited invasive examinations and left the primary disease unclear. Despite symptomatic therapy, malnutrition and hypovolemia were prolonged, and he died. The definitive diagnosis of sclerosing mesenteritis and the cause of the fatal outcome were disclosed at autopsy. This case indicates that sclerosing mesenteritis is a potentially-fatal disease and the need for aggressive treatment should be discussed.
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Affiliation(s)
- Takashi Kida
- Department of Gastrointestinal Medicine, Matsushita Memorial Hospital, Japan.
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Sclerosing mesenteritis as a cause of abdominal mass and discomfort in an elderly patient: a case report and literature review. Case Rep Med 2010; 2010:625321. [PMID: 20671922 PMCID: PMC2910504 DOI: 10.1155/2010/625321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 05/22/2010] [Indexed: 11/18/2022] Open
Abstract
Sclerosing mesenteritis is a rare benign process that involves inflammation, fat necrosis, and fibrosis of the mesentery. The disease poses great diagnostic challenge due to its nonspecific clinical and diagnostic findings. We report the case of a 75-year-old man who presented with vague abdominal discomfort associated with an intra-abdominal mass. With suspicion of a bowel carcinoid tumor on computed tomography scans, the patient underwent diagnostic laparoscopy. A diagnosis of sclerosing mesenteritis was made on histological examination. The patient's symptoms responded to a combination of immunosuppressive drugs, with no interval change in the size of the mass on radiological examination after fifteen months.
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Abstract
Mesenteric panniculitis is a rare, benign and chronic fibrosing inflammatory disease that affects the adipose tissue of the mesentery of the small intestine and colon. The specific etiology of the disease is unknown. The diagnosis is suggested by computed tomography and is usually confirmed by surgical biopsies. Treatment is empirical and based on a few selected drugs. Surgical resection is sometimes attempted for definitive therapy, although the surgical approach is often limited. We report two cases of mesenteric panniculitis with two different presentations and subsequently varying treatment regimens. Adequate response was obtained in both patients. We present details of these cases as well as a literature review to compare various presentations, etiologies and potential treatment modalities.
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